On her way to a blue office filled with colorful weights and papered with inspirational athletic posters, Andréa Leiserowitz stops in the waiting room to smile and chat with a patient about his progress. Progress happens often in this office, where, as the only full-time physical therapist, Leiserowitz is helping patients change their lives for the better. Three and a half years ago, she founded the outpatient physical-therapy clinic at the Seattle Cancer Care Alliance, and now, she and part-time physical therapist Rachel Douglas are busy with the unique job of strengthening and rehabilitating patients diagnosed with any type of cancer, at any stage of treatment, at nearly any age.
Helping such a wide variety of people improve their quality of life is a rewarding process, and for Leiserowitz, it's also a very personal one. As an undergraduate student, Leiserowitz watched as close friend struggle with cancer.
"I was with him during that last year of his life, and I watched him move through those later stages. I saw him have a lot of problems with his mobility, a lot of severe pain, swelling and just poor quality of life, and I remember thinking at the time that it didn't need to be that way," she said. The day before she started physical-therapy school, her friend lost his battle, but his death inspired her studies. "I knew that I was interested in trying to help people like him, but I didn't know how to do it. I didn't know that this was an area in which physical therapists could work," she said.
General-oncology training for physical-therapy students is uncommon, but it turned out that one of Leiserowitz's professors at the University of Michigan specialized in oncology rehab. Because of that connection, she pursued training related to cancer at the National Institutes of Health and MD Anderson Cancer Center.
"Oncology rehab is a pretty rare specialization, which is unfortunate, because it's such an unmet need nationally when you think of the hundreds of thousands of cancer patients out there," she said. "People are not being taught how to exercise properly during chemo or radiation. They may have other medical problems or diagnoses concurrently or need scar-tissue management after surgery. Therefore, patients become very weak and are at risk for falls, fractures, infections and pain."
Between six and eight patients, referred by a physician, nurse practitioner or physician assistant, come to the physical-therapy clinic every day. Those numbers are projected to increase next year, when the department is expected to expand to three full-time physical-therapy positions. "We'll have potential to see more of these folks earlier in their cancer treatments before they get debilitated, which is really needed," Leiserowitz said.
One factor limiting treatment potential in the field is a lack of exposure; many physical-therapy students are not even aware that oncology training is a possibility. As an oncology rehabilitation instructor at the University of Puget Sound in Tacoma, Leiserowitz sees the need for more awareness firsthand. "Inevitably each year, I will have at least one student who says, 'Wow, I always wanted to work with cancer patients, but I thought I was going to have to invent the wheel. I didn't realize it's already invented.' There are already guidelines and rules. But there are really only a handful of programs nationwide," she said.
And Leiserowitz would like to see those programs grow. To help, she also started an oncology rehab group in Washington to help build a referral base and provide continuing education. She spends time with referring therapists to help them understand the specific needs of cancer patients. "We pay attention to the history of a patient's cancer, what kind of treatments they've had, and the kind of long-term consequences that may need to be addressed secondary to those treatments. We have specific guidelines to stay within for safety," she said.
Dealing with an illness can be much easier under the guidance of a physical therapist. Regular exercise and a healthy diet are crucial to overcoming challenges related to disease. "People who are on treatment who are exercising consistently have less nausea, less fatigue and less depression. They're going to have less muscle atrophy, and less loss of bone density, as well as a decreased incidence of many other common complications," Leiserowitz said. "If we can get all cancer patients on a good exercise program early on, this will help prevent a lot of the complications we commonly see."
She said this approach just makes sense. "You wouldn't sign up for the Seattle Marathon without training. Together, appropriate exercise and diet will help you get through those treatments as best as a patient can, and greatly reduce overall medical costs to the patient and society. Exercise gives patients a sense of control back into their lives."
Helping people in treatment to stay on — or start — a program that includes cardiovascular, strength and stretching exercises is an important part of the therapist's job. Embracing good nutrition habits is also critical, and therapists often refer patients to the SCCA dieticians. Having access to resources like nutrition and nursing care helps improve continuity of care and provides a holistic approach to fighting disease. "This is an amazing place to work because we are all located in the same building. If you have questions or concerns about someone, there's usually someone here who can see the patient, immediately if needed," Leiserowitz said.
Positive life changes
The rewards of such a holistic program are great, said Leiserowitz, who has helped people learn to walk again. "There has to be a silver lining in fighting any disease, whether it's cancer or something else — to have positive life changes occur, like eating properly, losing weight and exercising consistently throughout life will all decrease the risk for other cancers, heart disease, diabetes and lymph-node swelling," she said.
Making positive life changes is attainable for every patient, regardless of current physical status, whether the patient is an athlete or someone struggling just to tie a shoe. "Even people in hospice care can gain strength and function and actually increase their quality of life, and that's just a priceless gift," Leiserowitz said. "There's nothing more rewarding."